Archivi del mese: luglio 2013

Over the past several years we have heard hundreds of managers talk about the negative impact of complexity on both productivity and workplace morale. This message has been reinforced by the findings of major CEO surveys conducted by IBM and KPMG [PDF], both of which identified complexity as a key business challenge.

Agreeing on complexity as a problem is one thing, but doing something about it is quite another — particularly for managers who are already over-worked, stressed, and can barely keep up with their current workload. In fact, the Catch-22 of complexity is that most managers don’t feel that they have the time to focus on it: Having the problem precludes the ability to solve it.

With this dilemma in mind, we think it’s important for managers to have a strategic framework that they can use to address complexity in their own areas, at their own pace, in their own ways. So to that end, we would like to offer a “simple” seven-step simplification strategy. While we present these sequentially, they can be implemented in any order, depending on where you might be able to make the greatest difference most quickly. Over time however, it’s important to do all seven so that simplicity becomes a core capability of your organization and not just a one-time project.

Clear the underbrush. An easy starting point for simplification is to get rid of stupid rules and low-value activities, time-wasters that exist in abundance in most organizations. Look, for example, at how many people need to review and sign off on expense reports or small purchases; or how many times slide decks need to be reviewed before they are presented. If you can shed a few simple tasks, you will create bandwidth to focus on more substantial simplification opportunities.

Take an outside-in perspective. Simplification should be driven by the need to add value to your customers, either internal or external. So a key step in the process is to proactively clarify what your customers (internal or external) really want and what you can do to make them more successful. One manager, for example, took her team to visit a customer plant so that people could see how their product was actually used, which gave them ideas about how to improve it.

Prioritize, prioritize, prioritize. One of the keys to simplification is to figure out what’s really important (and what’s not), and continually reassess the priority list as new things are added.

Take the shortest path from here to there. Once it’s clear that you are working on the right things, root out the extra steps in core processes. Where are the extraneous loops, redundancies, and opportunities to make our processes as lean as possible?

Stop being so nice. One of the patterns that causes or exacerbates complexity is the tendency to not speak up about poor practices. This is particularly true when people hesitate to challenge more senior people who unintentionally cause complexity through poor meeting management, unclear assignments, unnecessary emails, over-analysis, or other bad managerial habits. To counter this trend, use constructive feedback and conflict to keep your colleagues (and yourself) honest about personal behaviors that might cause complexity.

Reduce levels and increase spans. Another source of complexity is the structural tendency to add layers of management, which often leads to managers supervising just one or two people. When that happens, managers feel compelled to add value by questioning everything that their subordinates are doing, which adds work and reduces morale. To reduce this kind of complexity and stay away from micromanaging, take a periodic look at the organization’s structure and find ways to reduce levels and management and increase spans of control.

Don’t let the weeds grow back. Finally, remember that complexity is like a weed in the garden that can always creep back in. Whenever you feel like you’ve got it solved, do steps 1 through 6 over again.

In today’s global, increasingly digital organizations, complexity is a growing drag on productivity and workplace satisfaction. Managers need to develop simplification as a core leadership capability and a critical component of the business strategy. Hopefully these steps will help you get started.

“There is a time for everything, and a season for every purpose under heaven.”

On its face, this well-known King Solomon wisdom, from the 3rd chapter of Ecclesiastes, delivers hopeful encouragement. But implicit in this passage is a somewhat hidden, and often troublesome paradox: A time for everything also implies nothing can be forever, and therefore, change is inevitable.

In the abstract, we accept the reality of change, but in practice we regard it like the medicine we know we need, but don’t want to take. And knowing change is inevitable doesn’t make the pill any sweeter.

In the marketplace, it was challenging enough to implement a change when we had the expectation of not having to do it again anytime soon. But in the 21st century, the bitter pill of change has acquired an unfortunate new characteristic: a frighteningly short duration.

Organizations that enjoy consistent success will make change an abiding element in their business model, rather than an intrusion to “the way we’ve always done things.” They’ll create a culture and environment where change can occur whenever necessary, without creating a casualty list.

Rick Maurer, author of “Beyond the Wall of Resistance,” conducted a survey of organizations that have implemented change. He identified four things they did to create a culture compatible with change.

1. Make a strong case.

Maurer found that “when change was successful, 95% of the stakeholders saw a compelling need to change.” Change must be accompanied by evidence of its importance. If you can’t make the case, perhaps it’s not the right thing to do — yet.

2. Establish the vision.

Maurer’s research indicates 71% of successful changes happened “when people understood the vision of the project.” Stakeholders should see the long-term benefits of change.

3. Sustain the changes.

The primary reason for failure, Maurer found, was “inability to sustain the change.” Sustaining change isn’t a sprint; it’s a marathon that must endure pressure from many sources and may be the greatest test of leadership.

4. Anticipate maintenance.

Successful managers recognize that it’s not in the nature of change to be self-perpetuating.

Finally, behavioral studies have established that when something positive (or negative) is expected, that’s what is likely to happen. It’s called the Pygmalion Effect and it can be very powerful, either way.

Change will happen. And if we expect something positive, it probably will be.

Jim Blasingame is one of the world’s leading experts on small business and entrepreneurship. He is the creator and award-winning host of the nationally syndicated radio program, The Small Business Advocate® Show. In addition to his weekly columns, Jim is the author of two books; Small Business is like a Bunch of Bananas and Three Minutes to Success.

AchieveIt explains a process for creating a mission statement in a whitepaper, “Mission Statements: A How-To.”

AchieveIt suggests conducting a one-day retreat to create a strong mission statement. Here are 12 steps to create a mission statement from the whitepaper:

Preparing for the retreat
1. Each participant brainstorms about why the organization exists, chooses his or her best answer and writes it in 10 words or less.
2. Participants submit their statements, which the retreat leader writes on Post-It notes.

The retreat
3. Randomly stick all submitted mission statements on the wall.
4. Participants group mission statements by major themes.
5. Participants choose a heading of three words or less for each group.
6. Participants rearrange mission statements if they no longer fit under their heading.
7. Each participant receives a number of single-color dots equal to about half the number of mission groups. Participants use the dots to vote on the mission statement(s) they think best reflects the organization. The two mission groups with the most votes go to the next stage.
8. Each participant chooses a word or phrase in any of the mission statements that inspires him or her. The retreat leader writes the three words or phrases with the most votes on Post-It notes.
9. Arrange the words and phrases with their group heading.
10. Use the words and ideas to frame the mission statement. If the chosen words do not naturally frame the mission statement, each participant writes a mission statement under 10 words using the key words and phrases.
11. Pair participants to share and combine their mission statements into one statement of 10 words or less. Combine pairs to create teams of four and combine the two mission statements into one. Repeat this process until only two teams and two mission statements remain.
12. The two teams present their mission statements and combine if possible. Otherwise, each participant votes once on a mission statement, and the statement with the most votes wins.

Since the 1980s, doctors and patients have been encouraged to share decision-making. Proponents argue that this approach promotes doctor-patient communication, enhances patient satisfaction, improves health outcomes and even may lower cost.

Yet, a hospital-based study found that patients who want to participate in their medical decisions end up spending more time in the hospital and raising costs of their hospital stay by an average of $865.

The findings, published in May 27 issue of JAMA Internal Medicine, came from the first hospital-based study to examine how patients’ desire to participate in medical decisions affects their use of health care resources.

There are about 35 million hospitalizations each year in the United States. If 30 percent of those patients chose to share decision-making rather than delegate that role to their doctors, it would mean $8.7 billion of additional costs per year, according to the study.

David Meltzer

“The result that everyone would have liked, that patients who are more engaged in their care do better and cost less, is not what we found in this setting,” said study author David Meltzer, associate professor of medicine, economics and public policy at the University of Chicago. “Patients who want to be more involved do not have lower costs. Patients, as consumers, may value elements of care that the health care system might not.”

The researchers approached all patients admitted to the University of Chicago’s general internal medicine service between July 2003 and August 2011. Almost 22,000 people, about 70 percent of those asked, completed a wide-ranging 44-question survey.

The key multiple-choice item for this study was: “I prefer to leave decisions about my medical care up to my doctor.” More than one-third of patients (37.6 percent) definitely agreed, one-third (33.5 percent) somewhat agreed, and a little less than one-third (28.9 percent) somewhat or definitely disagreed.

Patients who preferred not to delegate decisions to their doctors—those who wanted to work with their caregivers to reach decisions—spent about 5 percent more time in the hospital and incurred about 6 percent higher costs.

“Was I surprised?” asked Meltzer. “I wasn’t shocked. It could have gone either way. Our results suggest that encouraging patients to be more involved will not, alone, reduce costs.”

In fact, the authors note, “Policies that increase patient engagement may increase length of stay and costs.”

Although this was a large study, it may not apply in every setting, the authors cautioned.

“We need to think harder and learn more about what it means to empower patients in multiple health care settings and how incentives facing both patients and caregivers in those settings can influence decisions,” Meltzer said.

Indeed, the authors looked at “hospitalized patients, for whom providers have large incentives to decrease utilization due to Medicare prospective payment, low payment rates for Medicaid and uninsured patients, and utilization review for most patients.”

They found that provider incentives were not the only predictors of care costs. Although the uninsured had slightly shorter stays and lower hospitalization costs, patients with public insurance such as Medicare or Medicaid, which pay less than the cost of care, had longer than average stays and higher costs.

As the principal tertiary care hospital on Chicago’s South Side, the University of Chicago Medicine provides care for a diverse population. Three-quarters of the patients in this study were black. More than half had a high school education or less. Nearly 80 percent were insured by Medicare or Medicaid or had no insurance.

“This isn’t about demographics,” Meltzer said. Patients with the most education had lower costs than those with the least education, the study found.

Nonetheless, the authors expressed particular concern about the tendency for older, less-educated, publicly insured and black patients to be less engaged in medical decision-making. They warned this could increase health care disparities as empowered and engaged groups, who already are more likely to receive care, gain resources through shared decision making while the national movement toward accountable care organizations increases the pressure for cost reduction.

“We want patients to be more involved, to have the richest form of interaction,” Meltzer said. “That can align preferences, prevent mistakes and avoid treatments patients don’t want. But we need to find ways to create functional doctor-patient partnerships that lead to good health as well as sound decisions about resource utilization.”

Additional authors were Hyo Jung Tak and Gregory Ruhnke of the University of Chicago Medicine. Funding for this work was provided by the Agency for Healthcare Research and Quality, the National Institute on Aging and the National Cancer Institute.

Last month we published a plea from Dave deBronkart (also known as e-Patient Dave) to “let patients help.” As a survivor of stage IV, grade 4 renal cell carcinoma, he described how the online patient community helped save his life (BMJ 2013;346:f1990). His aim is nothing less than to revolutionise the relationship between patients and healthcare providers. “Please,” he wrote, “let patients help improve healthcare. Let patients help steer our decisions, strategic and practical. Let patients help define what value in medicine is.”

This week we hear from another e-Patient, Kelly Young, who tells us why she became “a rheumatoid arthritis warrior” (doi:10.1136/bmj.f2901). Her blog,rawarrior.com, was born of the realisation that her doctors were stumped and that she needed to take responsibility for understanding her condition and deciding about her care. The blog now reaches nearly 2% of all patients with rheumatoid disease in the United States and, according to Young, is changing the way doctors as well as patients think about the disease.

The language of revolution and war may seem excessively violent, but it reflects the sense that even internet empowered patients feel they must fight to be heard, to get access to information, and to have their say in treatment decisions.

The BMJ is a journal for doctors. Over the years we have resisted the temptation to widen our sights to include patients among our target readership, although we know that many of our online readers are patients and members of the public. Despite its name, our series of Patient Journey articles is not designed for patients. As recently summarised by the BMJ’s patient editor, Peter Lapsley (BMJ 2013;346:f1988), these articles aim to give our medical readers new insights into patients’ experiences of illness and treatment in order to improve care.

But Young, deBronkart, and others like them are looking for something more than simply more empathetic doctors. They want partnership on an equal footing. And it’s this shift that the BMJ now wants to champion, working with colleagues at the Mayo clinic and others. As several of us ask in an Editorial this week, how better to improve care than to enlist the help of those whom the system is intended to serve?

Achieving such a partnership is a challenge. Years of paternalism have left doctors and patients unprepared for a different type of interaction. Time and other pressures may seem to justify current ways of working. But what if taking steps to bridge the divide between doctors and patients really did result in better, less costly, more effective care? There is a growing evidence base to suggest that it will. Ten years ago, we published a theme issue on partnering with patients (www.bmj.com/content/326/7402), and other articles published before and since are now gathered in a collection on bmj.com(www.bmj.com/bmj-series/shared-decision-making). To encourage further research and thinking in this area, the BMJ plans a call for papers for a conference and theme issue on participatory care next year. More information will follow shortly. Meanwhile, we are recruiting a panel of patients and doctors to help us think about how we can reflect the shift to patient partnership. I’d welcome your thoughts.

With the NHS facing huge challenges in emergency, acute and primary care, finances squeezed and a new commissioning landscape to navigate, now is the perfect time to invest in developing leaders, says Karen Lynas

What is the thing you wish you had known before you took the job you’re now doing? If you could write a letter to your younger self about how to prepare for it, what would it say? Would it be about the skills and knowledge you needed but didn’t have − and didn’t know you needed until you started? Or about the people you would be working with and how you needed to learn a bit more about yourself to manage them well and positively? Would it be about the energy, enthusiasm, tenacity and resilience you were going to need? Maybe it would concern how to network better? Or perhaps something else entirely.

‘The leadership role is complex at every level. Getting it right is tough and getting it wrong is disastrous’

We have such a diverse range of leadership roles in the NHS that understanding the role you are about to move into can be difficult; preparing for it even harder. The truth is we haven’t yet done what most industries do routinely and what many FTSE 500 companies describe as one of their “differentiating success factors”: provide structured development to spot, nurture, train and support leaders in their organisations to prepare them for their next role.

If you are really lucky, your organisation will do this − and there have been some excellent regional initiatives supporting people in transition. But the NHS has never put industry-wide, sufficiently resourced, high-quality leadership development in place − a system that would prepare people for their next role rather than help them once they’ve moved. Until now.

Be prepared

The leadership role is complex at every level. Getting it right is tough and getting it wrong is disastrous to the people who most need our support. So the NHS Leadership Academy is attempting to change that. We have put together five national core programmes, from entry level to the most senior leadership roles in the service.

Open to all those working in health and care and NHS funded care, these programmes exist to help prepare you for your next leadership role, and successful completion leads to an award that demonstrate your readiness to do the job.

‘NHS staff need new solutions, new skills, new knowledge and new ways of leading, engaging and motivating others’

Why choose now to take people away from their jobs to develop their leadership potential? What’s the benefit of investing all this money?

The answer is these challenges make it precisely the time we need to do it. This work isn’t a distraction from solving the problems we are all currently facing − it is a big part of the solution. We have a whole new architecture being led in many parts by people new to the role and struggling to find their way through what they have inherited − they need support, wisdom, knowledge and experience.

A simple solution

We have staff working in provider organisations who truly can’t continue to do more of the same − just harder and faster, while getting those around them to do the same. They need new solutions, new skills, new knowledge and new ways of leading, engaging and motivating others.

‘Let’s not leave it to chance anymore − moving into a job you think you might know but have never been properly developed to do’

If the NHS is to survive as a service that meets the changing needs of our population, then it also needs to change to meet its own needs. I don’t think we should expect those leading our services, at whatever level and from whatever profession, to be able to do that without real support and development. That includes learning from the best in the service, from other industries and from other health systems. It includes looking at their challenges with new eyes and fresh ideas; rethinking how the way they lead can liberate and engage the people who work with them.

It is this kind of radical thinking and support that will contribute significantly to moving us from where we are now to a safer, more sustainable, more effective, response and innovative NHS.

So let’s not leave it to chance anymore − moving into a job you think you might know but have never been properly developed to do. Where you are expected to have all the answers when you barely know the right questions, or absorb through osmosis all you should know about the impact your leadership has on others. And whether that is good, bad or indifferent.

You deserve to be supported to learn with others about how together we can start to change the way we work right across the system. Invest in your staff and they’ll look after the rest − it’s that simple.

The difficult challenge of making cuts to budgets while also ensuring patient choice and satisfaction is something every new clinical commissioning group (CCG) will face in coming months. How can NHS organisations give patients and the local community a say in how money is spent on their healthcare?

The STAR programme aims to help. It is developing a commissioning support package that will offer CCGs and health boards a new way to involve stakeholders in setting healthcare priorities. The Heath Foundation is working on the programme in partnership with the London School of Economics (LSE), PricewaterhouseCoopers and representatives from commissioning groups and public health observatories, building on our research into ‘Commissioning with the community’.

What is STAR?

STAR stands for ‘Socio-technical Allocation of Resources’. It combines a rigorous, technical, value for money analysis with a social approach that involves commissioners, providers, the local public and patients. It was developed by an LSE team led by Professor Gwyn Bevan, as part of a programme of research funded by The Health Foundation from 2008 to 2010, and has been piloted successfully by both NHS Isle of Wight and NHS Sheffield.

The STAR programme aims to produce a toolkit that will be freely available to health services throughout the UK. The toolkit will have three parts:

A decision support tool to engage stakeholders in comparing the value for money of different services. It will do this by estimating the costs of interventions, the number of patients affected, and their benefits. These assessments will draw from local data, clinical and epidemiological evidence, and expert judgments of involved stakeholders.

A training module on facilitating decision conferencing. This technique empowers people without technical knowledge to take part effectively in multi-criteria decision analysis. It highlights conflicts, allows options to be properly assessed, and adds transparency and accountability to decision making.

An evidence-based approach to priority setting, integrating patient experience into the decision-making process.

Why is STAR’s approach important?

Helen Knowles, Senior Public Health Manager at Bedfordshire CCG and a member of the STAR stakeholder group, says: ‘In the past, stakeholders have had variable involvement in decision making, depending on the area. The most exciting thing about this work is that we aim to involve stakeholders in a more meaningful way. If the toolkit is working well, it will make the information more readily accessible to stakeholders and lead to a better process for priority setting.’

Phil da Silva, Director of Commissioning Development at Derbyshire CCG, is another member of the stakeholder group. He says: ‘The ambition is to bring something together that uses a lot of the experience of commissioners, but in a simpler format. What’s exciting is the involvement of patients and population in planning and designing health services, along with clinicians.’

Where did the approach come from?

Between 2008 and 2010, The Health Foundation supported a programme of research into value for money in healthcare at LSE. The LSE team combined concepts of cost effectiveness from health economics with the socio-technical approach of decision conferencing to help health services to improve value through commissioning decisions. Decision conferencing has been developed over the past thirty years to support decision making that involves multiple stakeholders and conflicting values.

The LSE team tested the approach successfully with NHS Isle of Wight and NHS Sheffield. The Isle of Wight PCT used the outcomes of its decision conferencing to set priorities in its use of growth money, for which it was awarded a prize by South Central SHA. The LSE team developed the approach further in collaboration with NHS Sheffield, and this informed the local commissioners in deciding how to reallocate resources within current budget limits.

What does STAR hope to achieve?

The transparency of decision making offered by STAR may enable decisions to be made more quickly, as all stakeholders can see and understand the data. Ultimately, the programme aims to improve the health of patients and population, by enabling commissioning groups to involve the wider community in the decisions that affect them so greatly.

As summer approaches, there are a number of good books you may want to consider that will not necessarily make the top 10 lists but that will provide food for thought. These books are not mysteries, psychological thrillers, romance novels or historical fiction. These are books that offer keen insights into leadership and management challenges, which on a day-to-day basis can bring their own dramas, twisting plot lines and, in this city, political intrigue.

(amazon.com)

A good place to start is the latest book from Chip and Dan Heath, Decisive: How to Make Better Choices in Life and Work. In their classic conversational style, the Heath brothers present a well researched, easy reading book about improving decision-making on everything from personnel to personal actions.

The authors lay out leadership traps that include overconfidence, the tendency to seek out information that supports your own point of view and to downplay information that doesn’t, and the common habit of getting distracted by short-term emotions. The Heath brothers propose a four-step process designed to counteract these biases and, in doing so, provide real-life stories that include a rock star’s inventive decision-making trick and a CEO’s terrible acquisition.

You also may want to check out The Decision Book: 50 Models for Strategic Thinkingby Mikael Krogerus and Roman Tschäppler. This short book outlines several decision-making tools you can use, whether you’re looking to manage your time better, deliver a message that sticks, settle a dispute with a colleague, motivate your team, or help your team learn from mistakes. I rely on these models whenever I confront a tough decision.

Another title may seem less relevant to a federal audience, but Playing to Win: How Strategy Really Works by A.G. Lafley and Roger L. Martin offers great advice for leaders in any sector. Lafley is a former CEO of Procter & Gamble and, in close partnership with strategic adviser Martin, doubled P&G’s sales and increased its market value by more than $100 billion in 10 years.

In light of negative public perceptions and resource constraints, federal leaders would be wise to challenge themselves and their teams to answer Lafley’s and Martin’s central strategy questions: What is our winning aspiration? Where will we play? How will we win? What capabilities must we have in place to win? What management systems are required to support our choices?

At a more tactical level, you might check out Cass Sunstein’s new book, Simpler: The Future of Government. Sunstein, the former administrator of the White House Office of Information and Regulatory Affairs, has some common-sense tips leaders at any level can use to be more effective. Don’t impose requirements unless there are good reasons. Work with those likely to be affected by any policies or processes you want to put in place in an effort to avoid misunderstandings. Avoid jargon and speak in plain English. Make anything you produce as short as possible. This book should be on every federal leader’s reading list.

With many new leaders still taking the helm in the second Obama administration, a title both the incoming political appointees and their direct reports may want to check out is The First 90 Days, Updated and Expanded: Proven Strategies for Getting Up to Speed Faster and Smarterby Michael Watkins. The publication offers new leaders a reminder that effective transitions don’t just happen. They require thoughtful planning and effective execution, and this book offers the research-based, practical advice you need to succeed. This includes the most common pitfalls new leaders encounter and strategies you need to avoid them.

Many leadership books talk about the principles, best practices and role models you should follow without confronting the reality that leading is difficult. This book is worth a read to figure out the best approach to learning from, not just surviving, the experience. He argues that adversity is precisely what unlocks our greatest potential, and shares 151 stories to illustrate how the acceptance of the hard work of leadership can create true greatness.

Federal managers and employees, what books have you read recently that you might recommend to others? Please share your favorite titles below, or email me atfedcoach@ourpublicservice.org.

Tom Fox, a guest writer for On Leadership, is vice president for leadership and innovation at the nonprofit Partnership for Public Service and also heads the Partnership’s Center for Government Leadership.

All companies, whether they are successful with innovation or not, have one thing in common: they have their own “personalities.” These personalities are their unique organizational cultures – the shared experiences, values, norms, assumptions and beliefs that shape individual and group behavior, and that (for better or for worse) ultimately impact their business success.

The most innovative companies pull the right levers to create a culture that leads to exploration, experimentation, and the innovations that positively surprise the market, create competitive differentiation, and drive growth.

So how do you do it?

Needless to say, there’s no simple answer. Entire books, courses, and graduate school programs have focused on the topic.

This last week at the Front End of Innovation conference in Boston, I shared a presentation on the Strategies and Tools for Creating a Culture of Innovation. Anyone tasked with leading organizational or culture change initiatives focused on innovation might benefit from the Culture of Innovation Canvas that I shared during my presentation. It’s a simple tool (download PDF or download PowerPoint) for defining the following dimensions of an organization’s innovation culture:

Processes – How growth strategies and innovation are executed internally and externally including functional and cross-functional processes, customer engagement, information sharing, product and service development, and other activities

People – The mindsets and skillsets of employees, leaders, external partners and even customers tied to creative thinking, prototyping, and execution of new ideas and opportunities

Metrics, Rewards & Recognition – The mindsets and skillsets of employees, leaders, external partners and even customers tied to creative thinking, prototyping, and execution of new ideas and opportunities

Tim Cook, Apple’s CEO, recently said, “There’s no formula. If there was a formula, a lot of companies would have bought their ability to innovate.” When it comes down to it, every leader and every company has an opportunity to create their own unique formula for innovation. That’s the source of real innovation.

When I started researching creativity and innovation, one of the thought leaders I kept reading from again and again was Keith Sawyer. His book, Group Genius, was the first to truly examine collaborative creativity. His textbook, Explaining Creativity, was the first comprehensive review of creativity research. Naturally, I was inclined to read and review Keith’s newest bookZig Zag: The Surprising Path to Greater Creativity.

Zig Zag is a practitioner book. Although it is steeped in research, its coverage of that research is accessible to all. Likewise, there are practices and exercises throughout the book all designed to help enhance your creative ability. Zig Zag grew out of Sawyer’s Explaining Creativity, in which he summarizes all of the research on the creative process and arrives at an 8-stage model that all creativity and innovation efforts move through. Put simply, the eight stages are as follows:

Ask – how to ask the right questions for the most novel answers

Learn – how to prepare your mind for creativity

Look – how to be aware of the answers all around you

Play – how to free your mind to imagine possible worlds

Think – how to have way more ideas than you’ll ever need

Fuse – how to combine ideas in surprising new ways

Choose – how to pick the best ideas

Make – how to get your ideas out into the world to drive your creativity forward

While lots of creativity and innovation books promote their trademark process, one thing that makes Sawyer’s unique is his assertion (supported by research) that his eight stages aren’t really stages at all, not in the sense of a linear progression through stages. Instead, the creative process zigs and zags through these stages, doubling back or jumping around when necessary. This assertion has significant implications for organizations that are wed to the concept of a smooth, predictable process. When it comes to generating innovation products and services, Sawyer reveals, it takes a few zigs and zags.

Are successful entrepreneurial concepts the product of nature or of nurture? Do they spring unformed from the minds of inventors, or are they carefully cultivated adaptations of preexisting notions?

It’s not surprising that David Edwards, founder of experimental design lab Le Laboratoire, is a proponent of inventiveness: following through on crazy ideas that may or may not become profit generators. In his view, the potential to advance the human race is what should come first in any venture–and if one can do that, then a big payoff is likely not far behind.

Meanwhile, Krisztina “Z” Holly, creator of the first TEDx conference and an entrepreneur and engineer, preachesinnovation: building and iterating on existing ideas so they can have as great an impact as possible–and are more likely to attract investors from the get-go.

We put the two head-to-head to determine which mindset is more valuable when it comes to entrepreneurship.

Invention

David Edwards

Photography by Philippe Servent

Politically, environmentally, socially–the world is changing at a rapid clip. To David Edwards, a biomedical engineering professor at Harvard University and founder of Paris-based experimental art and design center Le Laboratoire, the key to adapting quickly is invention. “The development of new ideas that respond to new conditions has never mattered so much,” he declares.

The ability to translate an idea into commercial success is a special skill indeed, but it’s far more consequential to come up with an idea that redraws the very boundaries of what is possible. Consider the printing press, antibiotics and the internet: inventions that altered the course of history in ways “innovative” software and mobile startups can’t even approach. Revenue models certainly weren’t a big part of the development process for these inventions, yet countless opportunities arose (and are still arising) from their creation.

According to Edwards, support for wild ideas “so naive no one would encourage them” is lagging in the private sector. Rather, environments such as Silicon Valley promote the reworking of existing concepts–a process that is more easily taught and has more immediate gratification.

“To be in a position to see things in a fresh new way that others don’t see requires a perspective anchored in innocence and luck,” he says. “If you look at really successful inventors, they tend to be in positions that allow for that innocence, which is why many breakthroughs come from young minds.”

If the goal is to crack the world’s toughest problems, institutions of all types should foster creativity for creativity’s sake, and do what they can to nurture ideas that hold long-term promise. All that business stuff, meanwhile, will sort itself out.

For instance, Le Laboratoire produces exhibitions with the goal of presenting concepts that are so fantastical and thought-provoking that the public will pay to see them. And some of those projects do, in fact, become businesses. In 2010 and 2012 Edwards launched commercial ventures that grew out of such “open-ended” ideas: AeroDesigns, maker of AeroShot, a lipstick-size aerosol dispenser with which one can inhale medication, food or drink; and WikiCell Designs, maker of edible (and apparently tasty) packaging for food products like yogurt and ice cream.

More than just wild contrivances, these efforts could have important medical, nutritional and environmental applications.

In other words, Edwards believes far more great companies will arise from a culture that focuses on radical ideas than one more intent on building and funding, say, Pinterest 3.0. The future will shine brighter if we take a creative, multidisciplinary approach to entrepreneurship that encourages possibly reckless, avant-garde thinking that has the power to change the world.

As Thomas Edison once remarked, “Hell, there are no rules here–we’re trying to accomplish something.”

Innovation

Krisztina “Z” Holly

If you build it, there’s no guarantee they will come, argues Krisztina “Z” Holly, founding executive director of the USC Stevens Center for Innovation and MIT’s Deshpande Center for Technological Innovation and creator of the first TEDx conference. “Big ideas are just that–ideas–until you execute,” she says. “A lot of company leaders like to talk about thinking outside the box, but there are so many ideas out there already that are ignored, ironically, because they don’t fit in or are just way too ahead of their time. What we need to do is figure out what to do with the ideas we already have and make them work.”

By that, she means figuring out how these ideas will make money. “If the goal is to make as big of an impact as possible and change the way people live, work and play, you’ve got to sell the idea,” she says, pointing out that radical ideas rarely upend business paradigms by merely existing. For every PayPal that disrupts an established industry, for every Facebook that fundamentally alters the way people communicate, thousands of similar “inventions” never make it off the page.

But if entrepreneurs focus on innovation, on that backbreaking process of assimilating their businesses into the broader ecosystem–drawing on everything from technological improvements to cutting-edge marketing strategies to partnerships with big corporations–then the real breakthroughs will happen.

Without innovating on a proven quantity, you risk making zero impact. “I’ve seen many professors at USC and MIT with these unbelievable world-changing ideas,” Holly says, citing research into a procedure that simulates the effects of a gastric bypass surgery, but without the actual surgery. “But if surgeons don’t make money from it, who’s going to pay for it?”

Square is an example of a company that adapted an existing service–the credit card transaction–making it achievable over mobile devices and nearly single-handedly improving the purchasing process for both consumers and vendors. The company’s founders did not only rethink a timeworn business model; they made sure their process could be adapted (by integrating with other card networks) and monetized (with investment from Visa and partnerships with the likes of Starbucks).

If you want to build an amazing company, it isn’t enough to create something disruptive or rebellious. New ideas are a dime a dozen, Holly says; the real test is scaling your brainchild into a product with ubiquitous, tangible impact. “There’s this quote I love from Bob Metcalfe, the founder of 3Com and inventor of Ethernet: ‘Invention is a flower; innovation is a weed.'”

The fundamental problem in management is that the world is uncertain, and people hate dealing with uncertainty.

The result of this that they go to great lengths to provide themselves with the illusion of certainty. The Bed of Procrustres by Taleb, which I discussed previously, is primarily concerned with the problems caused by false certainty.

The problem with requiring certainty is that when you do, you fail to act. If you have to know in advance whether or not your innovation will succeed, you won’t innovate. If you have to know in advance whether or not your co-workers will perform, you won’t delegate. If you have to know in advance whether or not your idea will be accepted, you won’t put it forward.

The study found the two groups overwhelmingly agreed that nurse practitioners should be able to practice to the full extent of their schooling and training. But doctors were less likely to concur that advanced practice nurses should lead medical homes, which deliver team-based, coordinated care to patients.Only 17 percent of the 505 primary care physicians surveyed agreed with that notion, compared to 82 percent of the 467 nurse practitioners surveyed.

The two groups also disagreed about whether nurse practitioners should be paid equally for providing the same health services. More than 64 percent of nurse practitioners agreed with the idea of equal pay, as opposed to less than 4 percent of doctors.

The debate over the role of nurse practitioners has intensified as a result of concerns over a shortage of doctors as an estimated 25 million people gain insurance under the health care law. Nurse practitioners argue they can fill some of those needs if they are granted greater scope of practice.

That debate is reflected in the study’s finding about the groups’ conflicting views about the quality of care provided by doctors versus nurse practitioners. When researchers asked whether they felt the quality of care provided by physicians in exams and consultations was higher than that provided by nurse practitioners, more than 66 percent of doctors agreed, while 75 percent of nurses disagreed.

“We’ve done a lot of comparative surveys with health professionals but we’ve just never found gaps this big,” said Dr. Karen Donelan, an assistant professor of medicine at the Harvard School of Medicine and the study’s lead author. “When we get on the ground and we survey the people actually doing the work and working together, we see some of those professionals come closer together. We didn’t observe that here.”

Donelan pointed out that most nurse practitioners in the study — approximately 75 percent — said they are already practicing to the full extent of their training. Survey respondents who did not have this opportunity blamed their limited practice on state restrictions, hospital regulations and work setting.

During an interview, Donelan also said she was surprised by the level of disagreement in regards to the quality of care, since previous research findings have suggested little variation in the work done by nurse practitioners and primary care doctors.

Differences aside, Donelan’s study shows that the majority of practitioners in both groups agreed that increasing the number of nurse practitioners would improve timeliness of care. However, less than a third of doctors said such an increase would boost safety or effectiveness of care.

Nurse practitioners, on the other hand, overwhelmingly felt such an increase would improve care. Close to 81 percent, for example, thought the growth would improve access to health care for the uninsured and 77 percent said it would result in lower health care costs.

“As a team, this kind of inter-professional disagreement is not a good thing when we’re trying to achieve better teamwork,” Donelan said. “The conflict over roles has got to be worked out so that it’s clear for patients when they get their care.”

Moving forward, she said she hopes that both doctors and nurse practitioners will acknowledge their differences and bridge the gaps that keep them from working together.